白血病ppt课件
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Hypoplastic AL (lower than normal)
Blastic celቤተ መጻሕፍቲ ባይዱ and juvenile cells
HB+RBC Pt
Pictures Of Blood
Platelet White Cell
Red Cell
Platelet
Red Cell White Cell
Blasts
Remission
Red blood cells
Platelets White blood cells
Hematopoietic stem cell
ALL
Lymphoid progenitor
AML
Myeloid progenitor
naïve B-lymphocytes
T-lymphocytes
origin
Leukemia (ALL)
(CLL)
Hematopoietic Stem Cell
Lifespan
Decades
Years Months
Weeks, Days
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
CD14
T-ALL—CD3、CD2、CD7、
CD8
B-ALL—CD10、CD19、
CD22 、HLA-DR
cytogenetics and
molecular biology
Ｍ3
T(15;17)(q22;q21) PML-RARa
L1 T(9,22)(q34;q11) BCR-ABL
Acute leukemia
• ALL L3 (1%): cytoplasmic basophilia (Ig), vacuoles (Burkitt’s leukemia)
FAB of AML
Myelomono
AML
French-American-British (FAB) Classification M0: Minimally differentiated leukemia M1: Myeloblastic leukemia without maturation M2: Myeloblastic leukemia with maturation M3: Hypergranular promyelocytic leukemia M4Eo: Variant: Increase in abnormal marrow eosinophils M4: Myelomonocytic leukemia M5: Monocytic leukemia M6: Erythroleukemia (DiGuglielmo's disease) M7: Megakaryoblastic leukemia
Marrow failure
Fever Anemia
Bleedin g
Acute leukemia
Clinical features (二)
Anemia (progressive, weakness, pale) Fever (mostly by infection)
Common Severe Uncontrolled Pathogen：G-、G+、virus、fungus et.al
Definition
Hematopoietic stem cell malignancies
Malignant proliferation of leukemic cells
Infiltration of tissues Marrow failure Abnormality of WBC
Development of Leukemia in the Bloodstream
Stage 1- Normal
Stage 2- Symptoms
Legend
White Cell
Red Cell Platelet Blast Germ
Stage 5a- Anemia Stage 5b- Infection
Stage 3- Diagnosis
Stage 4- Worsening
Sources from Leukemia, by D. Newton and D. Siegel
Acute leukemia Clinical features
(三)
Bleeding Common、progressive locus：skin and mucous （purpura、ecchymosis ） Bleeding of internal organs
purpura
petechia ecchymosis
Normal human blood
Blood with leukemia
Acute leukemia
Laboratory (二)
Marrow blastic cells≥30%
数
的
normal blood cells reduced 异
hypoplastic leukemia
常
Auer rods
Plasma cells
Neutrophils Eosinophils Basophils Monocytes Platelets Red cells
Two-hit model of leukemogenesis
Loss of function of transcription factors needed for differentiation
Subclassification
• ALL
– Common type( pre-B) – B-cell – T-cell – Undifferentiated
• ALL L1 (85%): smaller, high n/c ratio, indistinct nucleoli
• ALL L2 (14%): larger, more cytoplasm, pleomorphic, more distinct nucleoli
质 的
异
常
Site for marrow samples
Marrow Biopsy:
Cellular or Hypercellular
Hypocellular
AML
•
Normal
Auer rods
ALL
Classification of acute leukemia
Methods 1.FAB 2.MICM
+
enhanced proliferation
Acute Leukemia
Classification of acute leukemia
ALL
• mainly children • M>F • curable in 70% of
children • curable in minority of
adults
eg. AML1-ETO
CBFb-SMMHC PML-RARa
Gain of function mutations of tyrosine kinases
eg. FLT3, c-KIT mutations N- and K-RAS mutations BCR-ABL
TEL-PDGFbR
differentiation block
Acute leukemia
Clinical features (三)
Infiltration of tissues/organs Lymph node, enlargement of liver and spleen
Bone pain CNSL（中枢神经系统白血病） Mouth、 skin 、eye（Granulocytic sarcoma ） Other（testis）
disease
Classification of leukemia
Myeloid origin
Acute
Acute Myeloid Leukemia (AML)
Chronic
Chronic Myeloid Leukemia (CML)
Lymphoid Acute Lymphoblastic Chronic Lymphocytic Leukemia
Lifespan
Decades
Years Months
Weeks, Days
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
Classification of acute leukemia
MICM
形态学 Morphology 免疫学 Immunology 细胞遗传学 Cytogenetics 分子生物学 Molecular biology
MPO (right) & Sudan black (left) showing intense localised positivity in blasts
AML
• mainly adults • M>F
• curable in minority of adults
Acute leukemia
Clinical features (一)
Malignant proliferation of leukemic cells
Infiltration of tissues
Leukemia （白血病）
陈方平
Leukemia
Outline
Contents
Classification
Acute leukema
Clinical features Diagnosis Therapy and Prognonis
Chronic leukema
What Is Leukemia?
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
Acute Leukemia
Hematopoietic Stem Cell
Chemotherapy
Hematopoietic Stem Cell
Residual leukemia stem cells
Infiltration of tissues (gum)
Infiltration of tissues (skin)
lymphadenopathy
Splenomegaly
Acute leukemia
Laboratory (一)
Blood test WBC+DC：Hyperleukocytic AL(＞100×109/L )
Method：two steps
Diagnosis
Differential diagnosis
Acute leukemia with normal amount of WBCs
①AA ②PNH
③ITP ④recovery of leukophenia ⑤MDS ⑥IDA
History
• Means “white blood” in Greek • Discovered by Dr. Alfred Velpeau in France,
1827 • Named by pathologist Rudolf Virchow in
Germany, 1845
Morbility
Morbility in adults
2.0
1.62
1.0
0.69
0.36 0.05
ANLL ALL CML CLL
Results in China（N/100,000
Etiology
Virus Radiation Chemicals Inheritance Other kinds of hematopoietic
• Cancer of the white blood cells
• Acute or Chronic
• Affects ability to produce normal blood cells
• Bone marrow makes abnormally large number of immature white blood cells called blasts
Acute leukemia
Laboratory（三）
Chemical dye L(淋) M（粒） N（单）
POX
- ++～+++ -～+
NSE
- -～++ +～+++
NaF
-
+
PAS
+～++ -～+ +～++
Acute leukemia
Laboratory(四)
Immunology ANLL—CD13、CD33、
Blastic celቤተ መጻሕፍቲ ባይዱ and juvenile cells
HB+RBC Pt
Pictures Of Blood
Platelet White Cell
Red Cell
Platelet
Red Cell White Cell
Blasts
Remission
Red blood cells
Platelets White blood cells
Hematopoietic stem cell
ALL
Lymphoid progenitor
AML
Myeloid progenitor
naïve B-lymphocytes
T-lymphocytes
origin
Leukemia (ALL)
(CLL)
Hematopoietic Stem Cell
Lifespan
Decades
Years Months
Weeks, Days
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
CD14
T-ALL—CD3、CD2、CD7、
CD8
B-ALL—CD10、CD19、
CD22 、HLA-DR
cytogenetics and
molecular biology
Ｍ3
T(15;17)(q22;q21) PML-RARa
L1 T(9,22)(q34;q11) BCR-ABL
Acute leukemia
• ALL L3 (1%): cytoplasmic basophilia (Ig), vacuoles (Burkitt’s leukemia)
FAB of AML
Myelomono
AML
French-American-British (FAB) Classification M0: Minimally differentiated leukemia M1: Myeloblastic leukemia without maturation M2: Myeloblastic leukemia with maturation M3: Hypergranular promyelocytic leukemia M4Eo: Variant: Increase in abnormal marrow eosinophils M4: Myelomonocytic leukemia M5: Monocytic leukemia M6: Erythroleukemia (DiGuglielmo's disease) M7: Megakaryoblastic leukemia
Marrow failure
Fever Anemia
Bleedin g
Acute leukemia
Clinical features (二)
Anemia (progressive, weakness, pale) Fever (mostly by infection)
Common Severe Uncontrolled Pathogen：G-、G+、virus、fungus et.al
Definition
Hematopoietic stem cell malignancies
Malignant proliferation of leukemic cells
Infiltration of tissues Marrow failure Abnormality of WBC
Development of Leukemia in the Bloodstream
Stage 1- Normal
Stage 2- Symptoms
Legend
White Cell
Red Cell Platelet Blast Germ
Stage 5a- Anemia Stage 5b- Infection
Stage 3- Diagnosis
Stage 4- Worsening
Sources from Leukemia, by D. Newton and D. Siegel
Acute leukemia Clinical features
(三)
Bleeding Common、progressive locus：skin and mucous （purpura、ecchymosis ） Bleeding of internal organs
purpura
petechia ecchymosis
Normal human blood
Blood with leukemia
Acute leukemia
Laboratory (二)
Marrow blastic cells≥30%
数
的
normal blood cells reduced 异
hypoplastic leukemia
常
Auer rods
Plasma cells
Neutrophils Eosinophils Basophils Monocytes Platelets Red cells
Two-hit model of leukemogenesis
Loss of function of transcription factors needed for differentiation
Subclassification
• ALL
– Common type( pre-B) – B-cell – T-cell – Undifferentiated
• ALL L1 (85%): smaller, high n/c ratio, indistinct nucleoli
• ALL L2 (14%): larger, more cytoplasm, pleomorphic, more distinct nucleoli
质 的
异
常
Site for marrow samples
Marrow Biopsy:
Cellular or Hypercellular
Hypocellular
AML
•
Normal
Auer rods
ALL
Classification of acute leukemia
Methods 1.FAB 2.MICM
+
enhanced proliferation
Acute Leukemia
Classification of acute leukemia
ALL
• mainly children • M>F • curable in 70% of
children • curable in minority of
adults
eg. AML1-ETO
CBFb-SMMHC PML-RARa
Gain of function mutations of tyrosine kinases
eg. FLT3, c-KIT mutations N- and K-RAS mutations BCR-ABL
TEL-PDGFbR
differentiation block
Acute leukemia
Clinical features (三)
Infiltration of tissues/organs Lymph node, enlargement of liver and spleen
Bone pain CNSL（中枢神经系统白血病） Mouth、 skin 、eye（Granulocytic sarcoma ） Other（testis）
disease
Classification of leukemia
Myeloid origin
Acute
Acute Myeloid Leukemia (AML)
Chronic
Chronic Myeloid Leukemia (CML)
Lymphoid Acute Lymphoblastic Chronic Lymphocytic Leukemia
Lifespan
Decades
Years Months
Weeks, Days
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
Classification of acute leukemia
MICM
形态学 Morphology 免疫学 Immunology 细胞遗传学 Cytogenetics 分子生物学 Molecular biology
MPO (right) & Sudan black (left) showing intense localised positivity in blasts
AML
• mainly adults • M>F
• curable in minority of adults
Acute leukemia
Clinical features (一)
Malignant proliferation of leukemic cells
Infiltration of tissues
Leukemia （白血病）
陈方平
Leukemia
Outline
Contents
Classification
Acute leukema
Clinical features Diagnosis Therapy and Prognonis
Chronic leukema
What Is Leukemia?
Red blood cells
Platelets White blood cells
Hematopoietic Stem Cell
Acute Leukemia
Hematopoietic Stem Cell
Chemotherapy
Hematopoietic Stem Cell
Residual leukemia stem cells
Infiltration of tissues (gum)
Infiltration of tissues (skin)
lymphadenopathy
Splenomegaly
Acute leukemia
Laboratory (一)
Blood test WBC+DC：Hyperleukocytic AL(＞100×109/L )
Method：two steps
Diagnosis
Differential diagnosis
Acute leukemia with normal amount of WBCs
①AA ②PNH
③ITP ④recovery of leukophenia ⑤MDS ⑥IDA
History
• Means “white blood” in Greek • Discovered by Dr. Alfred Velpeau in France,
1827 • Named by pathologist Rudolf Virchow in
Germany, 1845
Morbility
Morbility in adults
2.0
1.62
1.0
0.69
0.36 0.05
ANLL ALL CML CLL
Results in China（N/100,000
Etiology
Virus Radiation Chemicals Inheritance Other kinds of hematopoietic
• Cancer of the white blood cells
• Acute or Chronic
• Affects ability to produce normal blood cells
• Bone marrow makes abnormally large number of immature white blood cells called blasts
Acute leukemia
Laboratory（三）
Chemical dye L(淋) M（粒） N（单）
POX
- ++～+++ -～+
NSE
- -～++ +～+++
NaF
-
+
PAS
+～++ -～+ +～++
Acute leukemia
Laboratory(四)
Immunology ANLL—CD13、CD33、